Registration – World Kyokushin Kaikan Australia

Please indicate if this registration is for a child or an adult:

Child ( 6 - 11 years) Adult (12+ years)

Which program are you registering for?

Kyokushin Karate Yamane Ryu Kobudo Uchi Deshi - Far North Queensland

First Name

Last Name

Mobile

Date of Birth

Home address

Suburb, State, and Postcode

Emergency Contact Name

Emergency Contact Number

TERMS & CONDITIONS
I hereby agree to participate in the required physical activities and exercises as required for certification within the World Kyokushin Kaikan Australia courses conducted by World Kyokushin Kaikan Australia based on the terms and conditions set out below:
1. I hereby acknowledge an understanding of and agree to participate in physically demanding activities that, if done incorrectly, could be detrimental to my health.
2. I acknowledge that the training, while conducted in the safest possible conditions and under qualified supervision, involves physical contact and inherent risks, and I accept those risks. I agree to conduct myself in a safe and mature manner in accordance with the instructions from my instructors. I indemnify World Kyokushin Kaikan Australia, its proprietors, agents, and officers, including all instructors, staff members, and students, against any loss or damage they suffered concerning my participation in the training.
3. I confirm I am physically capable of participating in this training and that I have no existing medical condition which precludes or should reasonably preclude my participation.
4. I agree to release World Kyokushin Kaikan Australia, its proprietors, agents and officers, including all instructors, staff members, and students, from any liability whatsoever concerning my participation in the required physical activities and exercises within the World Kyokushin Kaikan Australia training programs. Without limitation, this includes all loss, damage or injury incurred as a direct or indirect result of my participation.
5. I agree that I will conduct myself in an appropriate manner and will always act in a way that is in the best interests of World Kyokushin Kaikan Australia.
I agree to all the above:

PHYSICAL READINESS QUESTIONNAIRE:
Note: The required training and exercises within World Kyokushin Kaikan Australia consist of but are not limited to, the following: Kumite (sparring), Kihon (karate basics and moving basics), Kata (functional set movements) and sports-specific exercise and conditioning techniques, and participants are required to complete the questionnaire below as a prerequisite before starting training with World Kyokushin Kaikan Australia for assessment of any special needs and/or considerations.

1. Has your doctor ever said you have a heart condition or vascular disease?

Yes No

2. Do you ever experience chest pains?

Yes No

3. Have you experienced any chest pain recently?

Yes No

4. Do you ever feel faint, dizzy, lose balance or lose consciousness?

Yes No

5. Has your doctor ever said you have high blood pressure (140/90)?

Yes No

6. Are you taking any medication for blood pressure or a heart condition?

Yes No

7. Are you a male over 35 or, a female over 45 and not accustomed to exercise?

Yes No

8. Do you have a bone or joint problem that could be made worse by a change in your physical activity?

Yes No

9. Do you suffer from asthma?

Yes No

10. Do you suffer from any other respiratory problems?

Yes No

11. Do you suffer from diabetes?

Yes No

13. Do you currently suffer from any illness not mentioned here?

Yes No

14. Do you know of any other reason why you should not participate in physical activity?

Yes No

To the best of my knowledge, I have answered the questions above truthfully. I understand and agree that it is my responsibility to inform World Kyokushin Kaikan Australia of any conditions or changes in my current and ongoing health that might affect my ability to participate safely in required exercises. By submitting this form, I understand that I have 7 days from the time the form was submitted to ask for a refund before the start of the training provided. After this period, I understand that I cannot receive a refund.

I/We agree to the terms and conditions above

Term Payment:

Term 1: (Jan, Feb, Mar) Term 2: (April, May, Jun) Term 3: (Jul, Aug, Sep) Term 4 : (Oct, Nov, Dec)

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